complex liver cyst

My husband, 41 years old and in good health, recently had a CT scan which revealed a "large, 3.9cm x 2.6cm, cystic lesion with thin septations identified within the medial aspect of the anterior superior segment of the right lobe of the liver near the inferior vena cava and confluent to the hepatic veins. There is some enhancement of the thin septations, however, no nodular enhancement is identified."  For the last two months or so, my husband has been experiencing some relatively mild upper right quadrant abdominal pain and a bloated feeling as well as some mild shortness of breath (frequent sighing). Also occasional gas-like cramps with loose stools. All of his standard blood work was normal. We have an appointment scheduled with a gastroenterologist, but in the mean time, I'm very worried about this complex liver cyst. I looked at the CT scan myself and there seems to be somewhere between two and six sections (or compartments) within the cyst. Also, my husband spends about two weeks a year East Africa and/or Central America leading tour groups and staying only at very nice, relatively exclusive, safari lodges.  My questions are: 1. How common are complex liver cysts? 2. How likely is this to be a parasitic cyst of Echinococcosis? 3. Is there an alternate explanation because I really hope it is not Echinococcosis. 4. Are most gastroenterologists familiar with Echinococcosis (We live in Ohio).  If our gastroenterologist suspects Echinococcosis, does it require immediate treatment?  5. Is it likely that this cyst is causing my husband's symptoms? 6. Does the cyst I described sound very unusual to you?  Any reassurance you could give me would be very much appreciated as we wait to see the gastoenterologist. Thank you.

[Kevin Pho, MD]

To answer your questions:
1) There are several kinds of liver cysts (polycystic, duct-related etc.) and the prevalence can vary with each type.

2) Imaging studies such as an ultrasound and CT scan can suggest Echinococcosis.  You can also do blood tests to confirm the diagnosis.

3) As mentioned before, there are many causes of liver cysts.

4) An infectious disease physician would probably know more about Echinococcosis.  Treatment for this normally consists of surgery - although chemotherapy and aspiration can also be considered.

5) Tough to say without examination.  It certainly is possible that the cyst may be responsible for the symptoms.

6) Again, difficult to say without examination.

I would consider discussing these options with your personal physician.  You can consider obtaining another GI evaluation for a second opinion if you are not comfortable with the approach taken.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[KRISYAN]

I have been having pain in my upper right quadrant quite freequently for the past 2 years. The is often start after a fatty meal. I am also feeling bloating or bubble like fluid in the same side. Usually after a meal, I must go to the toilet. Six month ago I visited my doctor for this issue. I had a liver function test done as well as a ultrasound for gallbladder. All were negative. I also notice a change in my bowel. It is softer than usual. My major concern is the feeling of extra fluid in that same side. Can someone give some idea of what can this be.